The staggering gap between official data and reality means that thousands of people die without an accurate diagnosis, according to a study by the British medical journal The Lancet. And the government is able to tout the malaria program’s success without a clear picture of how many people are dying. Malaria costs the country nearly $2 billion each year, and the impact of lost earnings and treatment bills falls disproportionately on rural, poor families. An extensive investigation by Al Jazeera America unearthed routine manipulation of malaria data, crippling shortages of essential supplies, chronic understaffing of hospitals and enduring dysfunction in World Bank–funded projects, which led to the Indian government’s returning millions of dollars in aid.

Many health officials privately acknowledge this systemwide failure but say they are helpless. In a review of hundreds of pages of program records, medical supply contracts and village health registers — as well as interviews with dozens of insiders — reporters found that the most serious failures often persist for years in plain sight.

A public health nightmare. Not just because people are dying from it, but also because it is a scourge that does not exist on paper.